The application value of TCD combined with CDUS in the large artery atherosclerosis

Shaobin Wang, Dong Wang, Weixing Huang


Objective: To explore the value of TCD and CDUS on diagnosis of large artery atherosclerosis.

Methods: In our study, 90 patients who had been admitted to our hospital and diagnosed as LAA according to CISS typing were selected as the research object. A retrospective analysis was conducted, using CTA as golden standard for diagnoses of stenoses. Explore the risk factors of LAA, the reliability of TCD and CDUS in diagnosis of the stenosis and distribution of stenosis in each vessel.

Results: Hypertension and type 2 diabetes are risk factors of LAA vascular stenosis. Middle cerebral artery stenosis detection by TCD carries the highest reliability (sensitivity 90.91%, specificity 97.89%, positive predictive value 96.15%, the negative predictive value was 94.9%, the positive likelihood ratio was 43.18, negative likelihood ratio 0.09, Kappa = 0.9). The consistency of TCD is as good as CTA in head and neck part. The negative coincidence rate was higher in the anterior circulation vessels (97.98%), followed by the coincidence rate of severe stenosis (95.23%). However, the detection rate of posterior circulation vessels positive, moderate and severe stenosis, mild stenosis gradually decreased by TCD. CDUS carries general reliability in detecting intracranial extracranial stenosis, the highest reliability in internal carotid artery (kappa 0.82), and the worst consistency in vertebral artery (kappa 0.38). The negative coincidence rate of CDUS in extracranial cerebrovascular stenosis was highest (97.22), followed by the overall compliance rate (91.55%). 242 branches of vascular stenosis were discovered in our study, among which intracranial artery stenosis 61.15% (148/242) is higher than that in extracranial artery 38.85% (90/242), ratio of moderate to severe stenosis is as high as 82.23% (199/242). Intracranial artery stenosis in ICA is extremely common (51.11%, 46/90), and MCA is the common area of intracranial artery stenosis (37.16%, 55/148).

Conclusions: (1) Hypertension, type 2 diabetes are risk factors for LAA stenosis. (2) TCD detection of intracranial vascular stenosis carries the best consistency, and reliability of MCA is the highest. In our search, MCA possesses the highest rate of stenosis, and negative coincidence rate by TCD examination was the highest, which could be used for screening method for stenosis. The reliability of TCD in diagnosis of moderate and severe stenosis was relatively better than mild stenosis. (3) CDUS detection of anterior circulation lesions is better than that of posterior circulation lesions. Evaluate effect on moderate and severe stenosis was better than that of mild one. The ratio of ICA stenosis was the highest, but the effect on VA was poor. (4) The incidence of intracranial vascular stenosis is more common than that of the intracranial vascular stenosis.

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